Stuttering and Articulation

I have a student who has both articulation and stuttering goals on his IEP. Which one do I target first?

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Stuttering and Articulation — 5 Comments

  1. Tricky area. Many SLPs report stuttering getting worse (or, with really young students, even developing) during traditional articulation therapy. On the other hand, focusing only on stuttering has the cost of poor intelligibility. When faced with this type of client, I spell it out for the parents (and always find they are more concerned about the stuttering). Often, the therapy ends up being fluency therapy and some sort of indirect phonology therapy. Again, such a plan is not without cost, but is often the best option. I hope this helps.

  2. I usually find this framework (Logan and Lasalle, 2003)helpful for treating stuttering with concomitant disorders:
    1. When stuttering is demonstrated to be primary communication problem, stuttering should be the primary focus of therapy.
    2. When stuttering and the concomitant articulation or language impairment are demonstrated to be of near equal priority, a cyclic method of therapy is recommended.
    3.When stuttering is demonstrated to be a low level of priority, the concomitant articulation or language problem should be the primary focus of therapy.
    The important thing is that you feel comfortable with your choice of intervention. Good luck and enjoy any approach you desire to use.

  3. I have found that I often can target both in the same session. As long as you are focusing on accurate but gentle placement of articulators it shouldn’t have a negative impact upon fluency. But of course every case is individual, this has been my experience clinically.

  4. When I do workshops on stuttering this question is one of the most frequently asked! My answer is-I weigh the priorities and often find the client, the parents and I agree that the stuttering goal is usually addressed first. Most often the stuttering has been ignored too long and the time for early intervention strategies has passed.
    I will provide some examples: Child, age 5 years, he has not had any therapy and has been stuttering since age 2. His parents have not enrolled him in therapy before age 5; they were assured by their pediatrician and friends that the stuttering would go away. The child is now closing his eyes and pushing his lips out with tension. He avoids talking in the classroom and will often nod his head, yes or no. When he talks at home, he only uses short phrases and his family understands his speech. He can’t say the R sound and says the word WED instead of RED. His parents have tried to help him say his R sound by telling him to growl like a dog and add more tension in his throat. In this case, I would definitely work on the stuttering first and tell the family not to work on his R sound. As soon as I judged the child had made substantial progress in fluency, and was capable of focusing on both fluency and his speech error I would begin working on his R production. I would caution the child to only tighten slightly to produce the R and make sure he provided a quick and light release rather than growling as his parents had taught him.
    In another case, I may work on both fluency and articulation. Example: A child is age 3 years and has been stuttering significantly for one year. There is a strong family history of stuttering and the child appears to have a very sensitive temperament. When the child’s family doesn’t understand him the child stutters severely, screams, hits them and throws toys. I would begin by instructing the parents to develop a list of about 10 short phrases that the child needs to say to obtain basic needs, such as food, drink and toys. They would gather the objects the child often desired. I would practice holding the objects up near my face and slowly saying the phrase, “I want ___(insert the word needed such as ball, cup, bear). With each phrase, I would use light, but clear contact for each sound and use a melodic pattern to my speech. When the child responded positively or attempted to imitate me, I would smile and hand the child the item. The family would be taught to repeat this activity and model the phrases when the child needed the item. I would demonstrate pausing and decreased language complexity. If a word was too difficult for the child to say then I would find a substitute. If the child’s sister was named Paulette, and the 3 year old could not say it, then I would ask the family to use the name Paulie. I would encourage the family to use the list of successful phrases in their own speech and to use fluency techniques with the child. I would expect the child to improve his fluency and his speech clarity at the same time. Both caused significant frustration and both needed to be addressed. An improvement in one area would likely improve the other. If the child was better understood then he would likely produce less tension in his speech musculature and it is likely his fluency would improve. If the child used clearer speech, the parents might be less stressed, they could pause more often, use a slightly slower speech rate and more melody. As the overall communication tension decreased we would expect a nice improvement in fluency and speech clarity.
    Every situation is unique and as therapists we use our best clinical judgment. We base our decisions on research as well as what works for each client. Good luck!

  5. I agree with many of the other comments, especially Nancy Barcal. Each case is indeed unique. I think that most of us can target both disorders at the same time. However, if this child is indeed old enough, I suggest asking the child which one is a priority in their life. Motivation to succeed is so powerful. I suggest that we use it!